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The audience applauds Mariela Castro, daughter of Cuban President Raul Castro, after she spoke at an academic conference at San Francisco General Hospital in San Francisco, Wednesday, May 23, 2012. Castro, an outspoken gay rights advocate, spoke at a medical lecture for health care providers on care for transgender patients. (AP Photo/Eric Risberg)

The audience applauds Mariela Castro, daughter of Cuban President Raul Castro, after she spoke at an academic conference at San Francisco General Hospital in San Francisco, Wednesday, May 23, 2012. Castro, an outspoken gay rights advocate, spoke at a medical lecture for health care providers on care for transgender patients. (AP Photo/Eric Risberg)